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Cardiac Surgery, Thoracic Surgery, Vascular Surgery

David M Shahian, David F Torchiana, Daniel T Engelman, Thoralf M Sundt, Richard S D'Agostino, Ann F Lovett, Matthew J Cioffi, James D Rawn, Vladimir Birjiniuk, Robert H Habib, Sharon-Lise T Normand
OBJECTIVES: Beginning in 2002, all 14 Massachusetts nonfederal cardiac surgery programs submitted Society of Thoracic Surgeons (STS) National Database data to the Massachusetts Data Analysis Center for mandatory state-based analysis and reporting, and to STS for nationally benchmarked analyses. We sought to determine whether longitudinal prevalences and trends in risk factors and observed and expected mortality differed between Massachusetts and the nation. METHODS: We analyzed 2003 to 2014 expected (STS predicted risk of operative [in-hospital + 30-day] mortality), observed, and risk-standardized isolated coronary artery bypass graft mortality using Massachusetts STS data (N = 39,400 cases) and national STS data (N = 1,815,234 cases)...
December 31, 2018: Journal of Thoracic and Cardiovascular Surgery
Daniel J Friedman, Jeffrey G Gaca, Tongrong Wang, S Chris Malaisrie, David R Holmes, Jonathan P Piccini, Rakesh M Suri, Michael J Mack, Vinay Badhwar, Jeffrey P Jacobs, Eric D Peterson, Shein-Chung Chow, J Matthew Brennan
PURPOSE: Patients with atrial fibrillation (AF) undergoing cardiac surgery are at substantially increased risk for stroke. Increasing evidence has suggested that surgical left atrial appendage occlusion (S-LAAO) may have the potential to substantially mitigate this stroke risk; however, S-LAAO is performed in a minority of patients with AF undergoing cardiac surgery. We sought to identify factors associated with usage of S-LAAO. METHODS: In a nationally-representative, contemporary cohort (07/2011-06/2012) of older patients undergoing cardiac surgery with preoperative AF (n = 11,404) from the Medicare-linked Society of Thoracic Surgeons Adult Cardiac Surgery Database, we evaluated patient and hospital characteristics associated with S-LAAO use by employing logistic and linear regression models...
February 2, 2019: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Alba Sánchez, Christine Thomas, Friederike Deeken, Sören Wagner, Stefan Klöppel, Felix Kentischer, Christine A F von Arnim, Michael Denkinger, Lars O Conzelmann, Janine Biermann-Stallwitz, Stefanie Joos, Heidrun Sturm, Brigitte Metz, Ramona Auer, Yoanna Skrobik, Gerhard W Eschweiler, Michael A Rapp
BACKGROUND: Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients' age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff...
January 21, 2019: Trials
Emily J Onufer, Darren R Cullinan, Paul E Wise, Laurie J Punch
OBJECTIVE: The "Surgery for Abdomino-thoracic ViolencE (SAVE)" animate lab engages surgical residents in the management of complex penetrating injuries. We hypothesized that residents will improve their understanding of the management of trauma patients and will perform skills that they have not previously performed in training. DESIGN: Pre- and postlab assessments were reviewed from surgical residents participating in the SAVE lab over 2 years (2017-2018)...
December 27, 2018: Journal of Surgical Education
Sengottuvelu Gunasekaran, Muthukumaran C Sivaprakasam, Vinodh Kumar PaulPandi, Abraham Oomman, Asha Mahilmaran, Mathew Samuel Kalarickal, Vijay Shankar Sadhasivam, Ganapathy Arumugam Chandrasekaran, Srinivasan Kanthallu Narayanamoorthy, Pramod Kumar Karaimbil Puthukavi, Sathyamurthy Immaneni, Rajeshwari Nayak, Louis Felix Sridhar, Paul Jude Ramesh Thangaraj, Sunder Thirugnanasambandan, Yusuf Meerangham Mohammed, Dheeraj Reddy, Dilip Kumar Mishra, Girinath Malligayil Ramakrishna
BACKGROUND: Despite the increasing popularity of transcatheter aortic valve replacement (TAVR), only about 10,000 TAVR cases have been performed in Asia to date. The procedure is still in a nascent stage in India with very few centers offering this state-of-art technique. Here, we present the early results of TAVR experience at our center. METHODS: Forty-nine patients with severe symptomatic aortic stenosis (AS) were referred to our center for TAVR from November 2015 to February 2018...
December 2018: Indian Heart Journal
Jung Hee Kim, Jong Hyun Baek
RATIONALE: Patent ductus arteriosus (PDA) ligation by open surgery is more difficult and dangerous in elderly patients than in infants. Nowadays, simple and safe interventional catheterization technology is used for the closure of uncomplicated isolated PDAs. Therefore, an alternative less invasive therapeutic option must be developed to treat complicated PDA. PATIENT CONCERNS: A 53-year-old woman presented with gradually exacerbated dyspnea on effort and continuous cardiac murmurs...
December 2018: Medicine (Baltimore)
Andreas Beckmann, Renate Meyer, Jana Lewandowski, Michael Frie, Andreas Markewitz, Wolfgang Harringer
Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2017 are analyzed. In 2017, a total of 179,337 procedures were submitted to the registry, and 101,728 were summarized as heart surgery procedures in the narrower sense. About 16.8% of these patients were at least 80 years old, resulting in an increase of 1...
November 2018: Thoracic and Cardiovascular Surgeon
Elena Bignami, Francesco Saglietti, Antonio Di Lullo
Mechanical ventilation during surgery is a highly complex procedure, particularly in cardiothoracic surgery, where patients need to undergo substantial hemodynamic management, involving large fluid exchanges and pharmacological manipulation of vascular resistance, as well as direct manipulation of the lungs themselves. Cardiothoracic surgery is burdened by a high rate of postoperative pulmonary complication (PPC), comorbidity, and mortality. Recent trials have examined various techniques to preserve lung function, although consensus on best practice has yet to be reached...
October 2018: Annals of Translational Medicine
John R Spratt, Melissa Brunsvold, David Joyce, Tom Nguyen, Mara Antonoff, Gabriel Loor
OBJECTIVE: We sought to examine the feasibility of a home practice curriculum of vascular anastomosis in cardiovascular surgery using a low-fidelity simulation platform and to examine its effectiveness in skill acquisition in senior surgical trainees. DESIGN: We organized a multicenter prospective randomized study of senior residents and fellows, who were oriented to a low-fidelity cardiac simulator and an 8-week curriculum of independent practice of aortic and coronary anastomosis...
October 23, 2018: Journal of Surgical Education
Jennifer L Halleran, Ryan D Baumwart, Danielle R Dugat, Robert N Streeter, Heidi Phillips
OBJECTIVE: To report the diagnosis and treatment of a companion dorper wether with patent ductus arteriosus (PDA). STUDY DESIGN: Case report. ANIMAL: An 8-month-old dorper wether presented to its primary care veterinarian for a persistent cough and was referred for suspected heart failure on the basis of physical examination and thoracic radiography. A PDA was diagnosed on echocardiography. METHODS: The sheep underwent cardiac catheterization and angiogram to measure pulmonary arterial and right ventricular (RV) pressures, identify the morphology of the PDA, and determine whether an intravascular occlusion of the PDA was feasible...
October 26, 2018: Veterinary Surgery: VS
Kei Takase
Recent introduction of multidetector-row computed tomography(MDCT) with more than 64 scanners enabled high-speed scanning in wide range of the body. Electrocardiogram (ECG) gated scanning and 4-dimensional imaging provides precise evaluation of cardiac and vascular diseases. Fine vascular structures such as the artery of Adamkiewicz can be visualized due to improved spatial and temporal resolution of CT and magnetic resonance imaging(MRI). Interventional radiology also plays important roles in combination with surgical treatment...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Nathan Belkin, Benjamin M Jackson, Paul J Foley, Scott M Damrauer, Venkat Kalapatapu, Michael A Golden, Ronald M Fairman, Rachel R Kelz, Grace J Wang
BACKGROUND: Length of stay (LOS) is a commonly used metric to optimize value in medical care. Although pathways have been developed for some procedures in vascular surgery to reduce LOS, they do not yet exist for thoracic endovascular aortic repair (TEVAR). The purpose of this study is to identify and define the risk factors for prolonged LOS in patients undergoing TEVAR to facilitate pathway development. METHODS: We included TEVAR patients in the National Surgical Quality Improvement Program database from 2005 to 2015...
September 11, 2018: Annals of Vascular Surgery
Piroze M Davierwala, Sergey Leontyev, Jens Garbade, Sven Lehmann, David Holzhey, Martin Misfeld, Michael A Borger
Background: Contrasting results of recent randomized controlled trials (RCTs) comparing off-pump and on-pump coronary artery bypass graft (CABG) surgery, as well as the lack of evidence for any survival benefit of bilateral internal thoracic artery (ITA) grafting over single ITA use, has intensified the debate about the role of the off-pump technique and bilateral ITA use in CABG surgery. We therefore investigated our 15-year experience in off-pump CABG with bilateral ITA grafting and evaluated temporal trends in preoperative characteristics and postoperative outcomes...
July 2018: Annals of Cardiothoracic Surgery
T Fuchs-Buder, N Settembre, D Schmartz
A hybrid suite is an operating theater with imaging equipment equivalent to that used in an angiography suite with computed tomography (CT) and magnetic resonance imaging (MRI). They are often situated outside the operating room area and typically serve as multifunctional rooms designed to support a variety of catheter-based endovascular procedures and open surgery to be performed in the same location. The possibility to perform these in the same location facilitates the combination of both approaches to so-called hybrid procedures...
July 2018: Der Anaesthesist
Hemang Yadav, Adam Bartley, Sheila Keating, Laurie A Meade, Philip J Norris, Rickey E Carter, Ognjen Gajic, Daryl J Kor
BACKGROUND: Patients who develop ARDS from medical or traumatic causes typically present after the inciting event has already occurred. Postoperative ARDS is unique in that the inciting insult potentially responsible for ARDS is known ahead of time, which provides an opportunity to study the early pathophysiology of ARDS. The objective of this study was to better understand the early pathophysiology of postoperative ARDS through a temporal analysis of key biomarkers of interest. METHODS: We performed a case-control study of adults undergoing elective thoracic, aortic vascular, or cardiac surgery, which placed them at increased risk of developing postoperative ARDS...
November 2018: Respiratory Care
Hyun-Chel Joo, Young-Nam Youn, Byung-Chul Chang, Kyung-Jong Yoo
Background: The efficacy and safety of off-pump coronary artery bypass grafting (OPCAB) in emergency revascularization remains controversial despite its widespread use. The aim of our study was to examine the applicability and safety of OPCAB in patients who were indicated for emergency surgery. Methods: This single-center study reviewed the indication, operative data, and early and long-term outcomes of 113 patients (mean age, 67.2±9.0 years; logistic EuroSCORE, 14...
April 2018: Journal of Thoracic Disease
Ioannis K Rizos, James N Tsoporis, Ioannis K Toumpoulis, Vasileios Salpeas, Shehla Izhar, Angelos G Rigopoulos, Eleftherios A Sakadakis, Thomas G Parker
Heat shock proteins (HSPs) play an important role in the cellular adaptation to stress, a requisite for cell survival. The aortic wall appears to be a target for increased expression of HSPs during surgical stress. We aimed to define the expression and function of aortic HSP70 in 31 patients with normal ascending thoracic aortic diameter who underwent aortic valve replacement due to aortic valve stenosis and in 35 patients with dilated ascending thoracic aorta who underwent replacement of an ascending thoracic aortic aneurysm...
August 2018: Journal of Cardiovascular Pharmacology
Diogo A Fonseca, Pedro E Antunes, Manuel J Antunes, Maria Dulce Cotrim
NEW FINDINGS: What is the central question of this study? Vasomotion has been viewed as a rhythmic oscillation of the vascular tone that is physiologically important for optimal tissue perfusion. Also, it has been studied primarily in the microcirculation. However, the precise underlying mechanisms and the physiological significance remain unknown. What is the main finding and its importance? Vasomotion is not specific to the microcirculation, as shown by our findings. In human arteries from patients undergoing cardiac surgery, an increased incidence was associated with endothelial dysfunction settings...
July 2018: Experimental Physiology
Hugo Silva, Andreia Fernandes, João Rodrigues, Daniel Brandão, Manuela Vieira, Catarina Celestino
INTRODUCTION: Endovascular aortic interventions are suitable alternatives to open surgery, being less invasive and having lower mortality and complications. Accurate positioning of the stent graft is a critical point because of systolic thrush. Techniques used to prevent it include pharmacological (antihypertensive drugs, nitroglycerin, adenosine) and mechanical methods (temporary caval occlusion by balloon). Rapid Right Ventricular Pacing (RRVP) is an emerging alternative with good patient tolerance and low level of complications...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
António Cruz Tomás, Álvaro Laranjeira Santos, Jorge Pinheiro Santos, Daniela Varela-Afonso, José Fragata
INTRODUCTION: The Frozen Elephant Trunk (FET) surgery allows correction of ascending, arch and proximal descending aortic pathology, using a hybrid prosthesis at the same time. It is a complex intervention and requires a multidisciplinary team that, besides scheduling and performing the surgery, accompanies the patient (pt) throughout the postoperative period. OBJECTIVES: To review short and medium term clinical results with this technique. METHODS: Between January 2010 and September 2017, we operated 34 patients (pts) using FET...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
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